Complaint Investigation Report

015601280-3-10-2022-15-AS-KHOS-CMKM88-20221229082241

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

CCLD Regional Office , 1515 CLAY STREET, STE. 310

This is an official report of an unannounced visit/investigation of a complaint received in our office on

03/08/2022 and conducted by Evaluator Grace Luk

COMPLAINT CONTROL NUMBER: 15-AS-20220308104946

Facility heating and cooling system is in disrepair

On 3/10/2022 at 9:20AM, Licensing Program Analyst (LPA) G. Luk arrived unannounced to conduct a complaint investigation and deliver findings in regards to the allegation above. LPA met with Administrator, Gina Velayo and informed her the reason for visit.

During the course of investigation, LPA interviewed 7 residents and 1 staff. Interview with residents revealed that R5's heater haven't been working since resident moved in about 2 weeks ago. LPA observed R5's heater has a broken button labeled "heat".

Based on LPA's information obtained during investigation, the preponderance of evidence standard has been met; therefore, the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, are being cited on the attached LIC 9099D. Exit interview conducted. A copy of this report and appeal rights provided.